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Ontogeny,growth and development of the small intestine:Understanding pediatric gastroenterology

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World Journal of Gastroenterology 2010年第7期16卷 787-799页

作者： Laurie A Drozdowski Tom Clandinin alan br thomson Medical Affairs Mead Johnson NutritionalsOttawaOntarioK1S 5N4Canada Department of Agricultural Food and Nutritional ScienceUniversity of AlbertaAlbertaT6G 2B7Canada Division of General Internal Medicine Department of MedicineUniversity of AlbertaAlbertaT6G 2B7Canada

Throughout our lifetime,the intestine *** alterations in its form and function may be genetically determined,and some are the result of adaptation to diet,temperature,or *** critical period programming of the intestine can be modified,such as from subtle differences in the types and ratios of n3:m6 fatty acids in the diet of the pregnant mother,or in the diet of the *** early forced adaptation may persist in later life,such as the unwanted increased intestinal absorption of sugars,fatty acids and ***,the ontogeny,early growth and development of the intestine is important for the adult gastroenterologist to appreciate,because of the potential for these early life events to affect the responsiveness of the intestine to physiological or pathological challenges in later life.

关键词： Intestinal development Ontogeny Pediatrics

Morphological,kinetic,membrane biochemical and genetic aspects of intestinal enteroplasticity

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World Journal of Gastroenterology 2009年第7期15卷 774-787页

作者： Laurie A Drozdowski M Tom Clandinin alan br thomson Medical Affairs Mead Johnson Nutritionals Department of Agriculture Food and Nutritional SciencesUniversity of Alberta Division of Internal Medicine Department of MedicineUniversity of Alberta

The process of intestinal adaptation("enteroplasticity") is complex and *** a number of trophic nutrients and non-nutritive factors have been identified in animal studies,successful,reproducible clinical trials in humans are *** mechanisms underlying this adaptive process may direct research toward strategies that maximize intestinal function and impart a true clinical benefit to patients with short bowel syndrome,or to persons in whom nutrient absorption needs to be *** this review,we consider the morphological,kinetic and membrane biochemical aspects of enteroplasticity,focus on the importance of nutritional factors,provide an overview of the many hormones that may alter the adaptive process,and consider some of the possible molecular *** most of the data is derived from rodent studies,wherever possible,the results of human studies of intestinal enteroplasticity are provided.

关键词：动力学形态学肠道生化遗传营养因素短肠综合征啮齿类动物

Celiac disease:Prevalence,diagnosis,pathogenesis and treatment

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World Journal of Gastroenterology 2012年第42期18卷 6036-6059页

作者： Naiyana Gujral Hugh J Freeman alan br thomson Faculty of Pharmacy and Pharmaceutical Sciences University of AlbertaEdmontonAB T6G 2E1Canada Department of Medicine University of British ColumbiaVancouverBC V6T 2B5Canada Division of Gastroenterology Department of MedicineUniversity of Western OntarioLondonON N6A 5A5Canada

Celiac disease(CD) is one of the most common diseases,resulting from both environmental(gluten) and genetic factors [human leukocyte antigen(HLA) and nonHLA genes].The prevalence of CD has been estimated to approximate 0.5%-1% in different parts of the ***,the population with diabetes,autoimmune disorder or relatives of CD individuals have even higher risk for the development of CD,at least in part,because of shared HLA *** gains access to the basal surface of the epithelium,and interact directly with the immune system,via both trans-and para-cellular *** a diagnostic perspective,symptoms may be viewed as either "typical" or "atypical".In both positive serological screening results suggestive of CD,should lead to small bowel biopsy followed by a favourable clinical and serological response to the gluten-free diet(GFD) to confirm the *** anti-tissue transglutaminase antibody or antiendomysial antibody during the clinical course helps to confirm the diagnosis of CD because of their over 99% specificities when small bowel villous atrophy is present on ***,the only treatment available for CD individuals is a strict life-long GFD.A greater understanding of the pathogenesis of CD allows alternative future CD treatments to hydrolyse toxic gliadin peptide,prevent toxic gliadin peptide absorption,blockage of selective deamidation of specific glutamine residues by tissue,restore immune tolerance towards gluten,modulation of immune response to dietary gliadin,and restoration of intestinal architecture.

关键词：诊断麸质治疗发病机理发病率过敏症转谷氨酰胺酶 HLA基因

Use of the tumor necrosis factor-blockers for Crohn's disease

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World Journal of Gastroenterology 2012年第35期18卷 4823-4854页

作者： alan br thomson Milli Gupta Hugh J Freeman Division of Gastroenterology Department of MedicineUniversity of Western Ontario Department of Medicine University of Alberta Department of Medicine University of British Columbia

The use of anti-tumor necrosis factor-therapy for inflammatory bowel disease represents the most important advance in the care of these patients since the publication of the National Co-operative Crohn's disease study thirty years *** recommendations of numerous consensus groups worldwide are now supported by a wealth of clinical trials and several *** general,it is suggested that tumor necrosis factor-blockers(TNFBs) are indicated(1) for persons with moderately-severe Crohn's disease or ulcerative colitis(UC) who have failed two or more causes of glucocorticosteroids and an acceptably long cause(8 wk to 12 wk) of an immune modulator such as azathioprine or methotrexate;(2) non-responsive perianal disease;and(3) severe UC not responding to a 3-d to 5-d course of *** TNFBs have been introduced and the patient is responsive,therapy given by the IV and SC rate must be *** remains open to definitive evidence if concomitant immune modulators are required with TNFB maintenance therapy,and when or if TNFB may be weaned and *** supportive evidence from a single study on the role of early versus later introduction of TNFB in the course of a patient's illness needs to be *** risk/benefit profile of TNFB appears to be acceptable as long as the patient is immunized and tested for tuberculosis and viral hepatitis before the initiation of TNFB,and as long as the long-term adverse effects on the development of lymphoma and other tumors do not prone to be *** the rates of benefits to TNFB are modest from a population perspective and the cost of therapy is very high,the ultimate application of use of TNFBs will likely be established by cost/benefit studies.

关键词：肿瘤坏死因子受体阻滞剂溃疡性结肠炎免疫调节剂成本效益糖皮质激素病毒性肝炎临床试验

Safety of the long-term use of proton pump inhibitors

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World Journal of Gastroenterology 2010年第19期16卷 2323-2330页

作者： alan br thomson Michel D Sauve Narmin Kassam Holly Kamitakahara Division of General Internal Medicine Faculty of Medicine University of Alberta Edmonton AB T6G 2B7 Alberta Canada

The proton pump inhibitors (PPIs) as a class are remarkably safe and effective for persons with peptic ulcer disorders. Serious adverse events are extremely rare for PPIs, with case reports of interstitial nephritis with omeprazole, hepatitis with omeprazole and lansoprazole, and disputed visual disturbances with pantoprazole and omeprazole. PPI use is associated with the development of fundic gland polyps (FGP); stopping PPIs is associated with regression of FGP. In the absence of Helicobacter pylori infection, the long-term use of PPIs has not been convincingly proven to cause or be associated with the progression of pre-existing chronic gastritis or gastric atrophy or intestinal metaplasia. Mild/modest hypergastrinemia is a physiological response to the reduction in gastric acid secretion due to any cause. The long-term use of PPIs has not been convincingly proven to cause enterochromaff in-like cell hyperplasia or carcinoid tumors. PPIs increase the risk of community acquired pneumonia, but not of hospital acquired (nosocomial) pneumonia. There is no data to support particular care in prescribing PPI therapy due to concerns about risk of hip fracture with the long-termuse of PPIs. Long-term use of PPIs does not lead to vitamin B12 def iciencies, except possibly in the elderly, or in persons with Zollinger-Ellison Syndrome who are on high doses of PPI for prolonged periods of time. There is no convincingly proven data that PPIs increase the risk of Clostridium difficile-associated diarrhea in persons in the community. The discontinuation of PPIs may result in rebound symptoms requiring further and even continuous PPI use for suppression of symptoms. As with all medications, the key is to use PPIs only when clearly indicated, and to reassess continued use so that long-term therapy is used judiciously. Thus, in summary, the PPIs are a safe class of medications to use longterm in persons in whom there is a clear need for the maintenance of extensive acid inhibition.

关键词： Acid inhibition Drug safety Osteoporosis Pneumonia Enteric infections

Recent advances in celiac disease

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World Journal of Gastroenterology 2011年第18期17卷 2259-2272页

作者： Hugh James Freeman Angeli Chopra Michael Tom Clandinin alan br thomson Division of Gastroenterology University of British Columbia Division of General Internal Medicine University of Alberta Department of Agricultural Food and Nutritional Science University of Alberta

Celiac disease now affects about one person in a hundred in Europe and North America. In this review, we consider a number of important and exciting recent developments, such as clinical associations, HLA-DQ2 and HLA-DQ8 predispositions, the concept of potential celiac disease, the use of new imaging/endoscopy techniques, and the development of refractory disease. This review will be of use to all internists, pediatricians and gastroenterologists.

关键词：疾病腹腔 HLA 审查内科胃

Nutritional modulation of the inflammatory response in inflammatory bowel disease-From the molecular to the integrative to the clinical

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World Journal of Gastroenterology 2007年第1期13卷 1-7页

作者： Gary E Wild Laurie Drozdowski Carmela Tartaglia M Tom Clandinin alan br thomson Department of Medicine Division of Gastroen- terology McGill University Montreal Quebec Department of Anatomy and Cell Biology McGill University Montreal Quebec Canada Division of Gastro- enterology University of Alberta Edmonton Alberta Canada Department of Physiology McGill Univer- sity Montreal Quebec Canada Department of Agriculture Foods and Nutri- tion University of Alberta Edmonton Alberta Canada

Nutrient deficiencies are common in patients with inflammatory bowel disease (IBD). Both total parenteral and enteral nutrition provide important supportive therapy for IBD patients, but in adults these are not useful for primary therapy. Dietary intervention with omega-3 polyunsaturated fatty acids contained in fish oil may be useful for the care of IBD patients, and recent studies have stressed the role of PPAR on NFκB activity on the potential beneficial effect of dietary lipids on intestinal function.

关键词：营养治疗炎症肠炎临床检查方法

Recent advances in small bowel diseases:Part Ⅰ

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World Journal of Gastroenterology 2012年第26期18卷 3336-3352页

作者： alan br thomson Angeli Chopra Michael Tom Clandinin Hugh Freeman Department of Medicine University of Western OntarioLondonON N6A 5A5Canada Division of General Internal Medicine University of AlbertaEdmontonAB T6G 2X8Canada Department of Agricultural Foodand Nutritional ScienceUniversity of AlbertaEdmontonAB T6G 2R1Canada Division of Gastroenterology University of British ColumbiaVancouverBC V6T 2B5Canada

As is the case in all parts of gastroenterology and hepatology,there have been many advances in our knowledge and understanding of small intestinal *** 1000 publications were reviewed for 2008 and 2009,and the important advances in basic science as well as clinical applications were *** Part Ⅰ of this Editorial Review,seven topics are considered:intestinal development;proliferation and repair;intestinal permeability;microbiotica,infectious diarrhea and probiotics;diarrhea;salt and water absorption;necrotizing enterocolitis;and immunology/*** topics were chosen because of their importance to the practicing physician.

关键词：小肠结肠炎疾病感染性腹泻胃肠病学临床应用基础科学肠道发育膜通透性

Intestinal mucosal adaptation

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World Journal of Gastroenterology 2006年第29期12卷 4614-4627页

作者： Laurie Drozdowski alan br thomson Nutrition and Metabolism Group University of Alberta Canada

肠的失败是营养不良或脱水由于营养素的不适当的消化和吸收描绘的一个条件。当功能的内脏团在为足够的营养素和水吸收必要的水平下面被减少时，肠的失败的最普通的原因是短肠症候群，它发生。这个条件可能是先天的，或可以由于小肠的巨... 详细信息

肠的失败是营养不良或脱水由于营养素的不适当的消化和吸收描绘的一个条件。当功能的内脏团在为足够的营养素和水吸收必要的水平下面被减少时，肠的失败的最普通的原因是短肠症候群，它发生。这个条件可能是先天的，或可以由于小肠的巨大的切除术被获得。后面的切除术，肠能够响应肠内的营养素以及另外的营养的刺激的改编。识别可以提高肠的改编的过程的因素是有重要潜在的临床的应用的研究的一个令人激动的区域。

关键词：黏膜疾病肠道运输形态学肠吸收